Every new mum has heard some version of it. "Oh, you're exhausted? Sure that's just the lack of sleep." And yes, broken nights are very much part of the deal. But new research suggests that for a significant number of women, tiredness after birth has a lot more going on beneath the surface than a few missed hours of shut-eye.
Research shows that more than half of postpartum women in high-income countries have low ferritin within just six weeks of delivery. Ferritin is the protein that stores iron in your body, and when it drops, the fatigue that follows can be profound. Not "tired after a hard week" tired. More like "I cannot function as a human being" tired. The kind that doesn't budge no matter how many naps you manage to grab.
Richa Puri, an independent prescribing pharmacist and registered nutritional therapist who specialises in women's hormonal health, says the postpartum period deserves far more careful attention than it typically gets. "The weeks and months after birth, often called the fourth trimester, deserve the same careful medical attention as pregnancy itself," she explains, "covering pain relief, mood, sleep and nutrition."
It's not just about sleep deprivation
The narrative around new-mum exhaustion tends to begin and end with broken sleep. Richa pushes back on that firmly. "Tiredness isn't simply down to sleepless nights," she says. "It's often a combination of nutrient deficiencies, a blood sugar imbalance, changes in hormones, or being under-fuelled if breastfeeding."
That last point is one a lot of new mums don't hear enough. When you're breastfeeding, your body is working incredibly hard, and if you're surviving on toast, crackers and whatever biscuit was nearest the kettle, you may genuinely not be eating enough to support recovery. Richa describes this as a "beige diet" — the kind of grab-and-go eating that's completely understandable given the chaos, but that quietly depletes the energy and nutrients your body is desperately trying to hold onto.
Beyond iron, thyroid problems are also surprisingly common after birth and frequently go undetected. Gaps in key vitamins and minerals built up during pregnancy don't simply resolve themselves once the baby is born. If anything, the demands of the postpartum period, especially if you're breastfeeding, can make things worse.
The six-week check matters more than you might think
The six-week GP check tends to focus heavily on the baby, which is as it should be. But Richa urges new parents not to let their own health slide by in that appointment. Iron levels, thyroid function and nutritional gaps are all areas she says deserve routine attention at that stage, not just a quick "and how are you feeling?"
She also points out that preparation before and during pregnancy makes a real difference. "Optimising nutrient intake before and during pregnancy sets women up far better for the fourth trimester than trying to fix deficiencies after the baby arrives, when reserves are already low." Research backs this up: nutritional quality tends to stay flat rather than improve from pregnancy into the postpartum period, meaning gaps that begin during pregnancy often persist well beyond birth.
What's safe to take when you're breastfeeding?
One of the trickier aspects of postpartum recovery is knowing what you can actually take. Pain, low mood and chronic exhaustion are common, but many women feel uncertain about medication while breastfeeding and end up simply going without. Richa says a prescriber or qualified nutritionist can check medication compatibility and interactions, so you don't have to choose between your own recovery and feeding your baby.
Her role bridges the gap between GP, public health nurse and nutrition advice, which can often feel fragmented and hard to join up. As a pharmacist prescriber she can look at the full picture — medications, supplements, diet — and work with your existing care team to help you actually recover, not just push through.
The "bounce back" culture around new motherhood puts enormous pressure on women to return quickly to how they looked and felt before pregnancy. But your body has just done something extraordinary. It needs rebuilding, not rushing. If the six-week check comes around and something still feels off, it's worth pushing for a proper review rather than accepting that this is simply how new motherhood feels.
Because sometimes tiredness really is just broken nights. But sometimes it's a lot more than that, and you deserve to know the difference.
Richa Puri (dipION, mBANT, CNHC, MPharm, IP) is an independent prescribing pharmacist and registered nutritional therapist specialising in women's hormonal health. Find out more here
